Governor Nathan Deal appears to be taking a page from President Obama’s playbook. Where the legislature has failed to pass certain initiatives, Deal is trying to accomplish the same through executive action.

Thursday, he proposed two ideas for advancing medical marijuana in Georgia, after a bill that would have done that died.

A few weeks ago, the governor directed his community health commissioner to do something for rural hospitals. Nine of them have closed in Georgia since 2000, leaving whole communities without quick access to emergency care.

But there are limits to what any governor can do alone.

This wave of rural hospital closures in Georgia started in Hancock County, halfway between Macon and Augusta. Hancock Memorial Hospital closed in 2001. Now, the building is overgrown.

Inside, the ceiling is collapsed and chunks of old computers line the floor.

Robert Moore chairs the board of Tri-County Health System, the primary care network in town.

“You just don’t have the financial support from the number of patients that you can have in a small rural hospital to maintain it,” said Moore.

He says when people in Hancock County need a hospital, they have travel 30 miles at least to Milledgeville or Sandersville. If patients have a more complex case, they must travel to Macon or Augusta. Both are an hour and half away.

The result is a dangerous lack of prompt emergency care in a part of the state that public health officials call Georgia’s “diabetes belt.” It’s a nickname that Hancock County Commission Chair Sistie Hudson at least a sense of humor about.

“We’re known for good cooks in Hancock County, “ she laughs.

The rural hospital crisis has become a political football in recent months. Republicans blame it on Obamacare. Democrats blame Governor Deal for not expanding Medicaid.

Jimmy Lewis, a lobbyist for Georgia’s small hospitals, says the main problem has been the state’s massive cuts in Medicaid reimbursements going back to 1999. Those are the payments the state gives healthcare providers for treating the poor and the disabled.

“We’ve cut the reimbursements on an annual basis about $1.5 billion, and that has reduced the per capita healthcare payments in the state of Georgia to Georgia being about number 47 or 48 on the list of payments,” said Lewis.

Combine that with a small and poor patient population, and Lewis says there just isn’t money in operating a rural hospital anymore.

But it may be cost-effective to operate something smaller than a hospital, like a standalone emergency room, or something just a little bigger than an urgent care clinic.

Right now there’s no legal framework that would allow for such a facility in Georgia, and legislation to create one died at the Statehouse last month. So the governor directed Community Health Commissioner Clyde Reese to look into administrative steps that could achieve the same end. Reese is forming a study committee, but he says this whole “rural semi-hospital idea” faces big challenges.

“They’re not going to be hospitals, they won’t be reimbursed as hospitals, they won’t be able to charge a facility fee, they won’t get the Medicaid add-on rate, et cetera,” said Reese.

In other words, Georgia’s byzantine healthcare system doesn’t provide enough ways for the operator of such a facility to get paid.

Could the state solve its rural hospital problem by funding healthcare directly? Unfortunately, Reese says that isn’t an option.

“No there’s no contemplation of that at the moment,” he said. “We’re not really looking to get into the healthcare facility business as a state.”

That political reality could leave rural healthcare in Georgia right back where it started — something that a few people really need, but no one wants to pay for.